Cookies on the NHS website
We've put some small files called cookies on your device to make our site work.
We'd also like to use analytics cookies. These send information about how our site is used to services called Adobe Analytics, Hotjar and Google Analytics. We use this information to improve our site.
Let us know if this is OK. We'll use a cookie to save your choice. You can read more about our cookies before you choose.
I'm OK with analytics cookies Do not use analytics cookies
Search the NHS website
Search
My account
Health A-Z
Live Well
Mental health
Care and support
Pregnancy
Browse
More
Home Health A to Z
Bladder pain syndrome (interstitial cystitis)
Bladder pain syndrome is a poorly understood condition where you have pelvic pain and problems peeing.
It's sometimes called interstitial cystitis (IC) or painful bladder syndrome (PBS).
It's difficult to diagnose BPS (interstitial cystitis) as there is no single test that confirms the condition.
Symptoms of BPS (interstitial cystitis)
The main symptoms of BPS (interstitial cystitis) include:
intense pelvic pain (felt over your lower tummy)
sudden strong urges to pee
needing to pee more often than usual
pain in your lower tummy when your bladder is filling up, which is relieved when you pee
waking up several times during the night to pee
Other symptoms can include finding it difficult to pee, urinary incontinence and blood in your urine (haematuria).
These symptoms can sometimes be caused by other conditions, such as cancer of the bladder. This is why you'll need a range of tests to rule out other possible causes before BPS (interstitial cystitis) can be diagnosed.
Ask for an urgent GP appointment or call 111 if you have blood in your urine and pain in your lower tummy.
Blood in your pee may be bright pink, red or dark brown.
Who gets BPS (interstitial cystitis)
Although BPS (interstitial cystitis) can affect people of all ages, it's much more common in women than men, usually over the age of 30.
The symptoms will often come and go over time. There may be times lasting days, weeks or months where your symptoms improve, followed by flare-ups when they're worse.
You might also find the pain is worse during your period or after having certain foods or drinks.
It can have a big impact on your everyday life, including work, mental health and relationships. But when a diagnosis is confirmed there are different treatments that can help.
What causes interstitial cystitis?
The exact cause of BPS (interstitial cystitis) is not clear. However, there are several ideas about what might cause it.
These include:
damage to the bladder lining, which may mean pee can irritate the bladder and surrounding nerves
a problem with the pelvic floor muscles used to control peeing
your immune system causing an inflammatory reaction
Some people who have been diagnosed with BPS (interstitial cystitis), may have a long-term (chronic) urinary infection (UTI) in the bladder, which has not been picked up by current urine tests.
BPS (interstitial cystitis) may also be associated with chronic conditions such as fibromyalgia, myalgic encephalomyelitis or chronic fatigue syndrome (ME/CFS) and irritable bowel syndrome (IBS).
When to see a GP
See a GP if:
you have pelvic pain that does not go away
you notice a change in your usual peeing pattern and it is affecting your daily life
Ask for an urgent GP appointment if you have blood in your pee.
What happens when you see a GP
BPS (interstitial cystitis) can have similar symptoms to long-term or frequent UTIs, so the GP may give you a urine test to check for a UTI.
Standard urine tests used in GP surgeries and hospitals may not pick up all infections of the bladder. You may be prescribed antibiotics to see if they help.
A GP may also suggest simple treatments such as:
keeping a food diary and avoiding foods and drinks that make your symptoms worse
stopping smoking – chemicals in tobacco can irritate your bladder
When to ask a GP for referral to a hospital specialist
Treatments from the GP may not always work. If your symptoms keep coming back or do not go away, ask the GP to refer you to a urologist specialising in female urology or a urogynaecologist.
Men may be referred to a urologist.
How is BPS (interstitial cystitis) diagnosed?
There is no single test to diagnose BPS (interstitial cystitis). You may have several tests to exclude other causes of your symptoms before a diagnosis can be confirmed.
The tests offered may include:
cystoscopy – a procedure to look inside your bladder using a thin camera called a cystoscope
urine tests
ultrasound, MRI scan or CT scan of the urinary tract and sometimes of the kidneys too
urodynamics – a range of tests to check the function of your bladder and urethra
vaginal swabs
Ask your doctor to explain what tests you are being offered and what they're for.
Treatments for BPS (interstitial cystitis)
When you have been diagnosed by a specialist as having BPS (interstitial cystitis), there are several treatments that may help.
No single treatment works for everyone, and there is no conclusive evidence they work. You may need to try several treatments to find one that works for you.
Ask your hospital specialist to explain the treatments offered to you and why.
Medicines
Tablets or capsules may be used to treat people with BPS (interstitial cystitis).
These include:
over-the-counter painkillers – such as paracetamol and ibuprofen
medicines for nerve pain – such as amitriptyline, gabapentin and pregabalin
tolterodine, solifenacin or mirabegron – these can reduce the urgency to pee
a prescription medicine that may help by blocking the effect of a substance called histamine in the bladder
pentosan polysulfate sodium (Elmiron) – this may reduce pain (this can only be prescribed by a specialist as it's only suitable for some people)
Bladder instillations
Some medicines can also be passed directly into the bladder using a thin tube called a catheter.
These are known as intravesical medicines or bladder instillations.
Examples of intravesical medicines include:
lignocaine - a local anaesthetic that numbs the bladder,
a mixture of compounds including steroids, sodium bicarbonate and heparin are used
hyaluronic acid or chondroitin sulphate – this may help restore the bladder lining
antibiotics alone or combined with a local anaesthetic and steroid – this can calm inflammation and reduce infection
As with oral medicines, the evidence is not conclusive for bladder instillations. Ask your hospital specialist to explain the different options.
Supportive therapies and treatments
Some people may also find the following therapies and supportive treatments helpful:
physiotherapy – a specialist pelvic floor physiotherapist can help you relax your muscles to ease pain.
acupuncture – may help with pain relief
talking therapies and counselling – to help you cope with your symptoms and their impact on your life
transcutaneous electrical nerve stimulation (TENS) – where a small battery-operated device is used to relieve pain by sending electrical impulses into your body
pain management – ask the GP to refer you to a pain specialist
Surgery and procedures
Surgery and other procedures may be recommended if you have clear abnormal areas (lesions) in your bladder or other treatments do not work.
Procedures that may be carried out include:
cauterisation – ulcers inside the bladder are sealed using an electrical current or laser
bladder distension – the bladder is stretched with fluid, which can aid diagnosis and may temporarily relieve symptoms
botulinum toxin injections (such as Botox) – injected directly into your bladder wall to temporarily relieve symptoms of frequent peeing and pain.
neuromodulation – an implant that stimulates your nerves with electricity is placed in your body to relieve pain and reduce sudden urges to pee
In very rare cases, and only as a last resort, it may be necessary to remove the bladder completely (cystectomy).
If this is done, your surgeon may need to create an alternative way for pee to leave your body.
Things you can do to help BPS (interstitial cystitis)
Things that may help improve your symptoms include:
reducing stress – try exercise, warm baths and mindfulness-based meditation techniques
making sure you are hydrated regularly throughout the day
keeping a food diary – if you notice certain foods or drinks (like citrus fruits and alcohol) make symptoms worse, avoid them, but ask for medical advice first
stopping smoking – the chemicals in cigarettes can irritate your bladder
Information:
More information and support
Bladder Health UK has information and forums on BPS (interstitial cystitis) as well as other bladder conditions
Page last reviewed: 18 February 2022
Next review due: 18 February 2025
Support links
Home
Health A to Z
Live Well
Mental health
Care and support
Pregnancy
NHS services
Coronavirus (COVID-19)
NHS App
Find my NHS number
Your health records
About the NHS
Healthcare abroad
Contact us
Other NHS websites
Profile editor login
About us
Accessibility statement
Our policies
Cookies
© Crown copyright